Landlocked, communist Laos has its isolation to thank
for keeping the global AIDS epidemic at bay while its Southeast Asian
neighbors struggle with some of the highest HIV infection rates in the
world.
But the United Nations fears attempts by the country to adopt a market
economy and open up to the outside world could spark a surge in
transmissions of HIV, the virus that causes AIDS.
"Laos has been the quiet achiever at keeping the spread of HIV at bay, but
this could all change," Tony Lisle, a top UNAIDS official in Southeast
Asia, told Reuters in an interview.
"The country is facing the same issues that its neighbors have faced in
the past, and the threat of HIV/AIDS is as big as ever. As the pace of
development increases, so does the AIDS risk."
A UN-World Health Organization report at the end of 2001 said Laos had an
HIV infection rate of 0.04 percent of adults between the ages of 15 and 49
-- a fraction of the equivalent rate of 2.7 percent in Cambodia and 1.8
percent in Thailand. Laos has around 5.4 million people.
The UN said Laos has hardly any migrant workers, few intravenous drug
users and the government had successfully educated its people about the
disease when infections began to rise in the mid-1990s.
Laos is one of the world's last remaining communist countries, and since
the demise of the Soviet Union in 1991 the secretive state's economy has
struggled.
The nation's currency, the kip, lost 90 percent of its value against the
U.S. dollar in the 1997-98 Asian financial crisis.
In a bid to boost its fragile economy, Laos has promoted tourism and
improved trade ties with its neighbors.
ROAD TO SEX
New roads are planned to link Laos with Thailand, Vietnam and China. A
domestic north-south route is also proposed.
But the social implications of this could be high. The UN fears improved
roads could bring disease along with foreign income.
"More truck drivers and construction workers will come across the borders
-- single men or men living away from their families --which will
inevitably increase the number of people working in the domestic sex
industry," Lisle said.
"Unlike its neighbors, Laos doesn't have a large sex-worker population or
a large client base, but this could all change."
Until the mid-1990s, the government restricted movement between provinces.
Wealthy individuals and businessmen were the only people allowed to leave
the country.
But poverty means large numbers of people are expected to travel to China
and Thailand to fish or work on building sites -- and the UN says many are
likely to be lured toward prostitution.
"Migrant workers may return to the country and spread the disease,
especially those who've worked in the sex industry," Lisle said.
"And those who stay in the country will inevitably move to the bigger
towns and cities. The temptation is there for Laotian women to work in the
sex industry and earn more money to support their families."

Can Laos keep AIDS at Bay?30/10/02 -- BBC News

Land-locked Laos is surrounded by some of the highest rates of HIV
infection in the world. Yet so far, Laos itself has largely escaped the disease. United Nations data says the number of people in Laos living with HIV at
the end of 2001 was about 1,500 or 0.05% of the population. The HIV rate among women working in the nascent sex industry in Laos was
about 1%, much lower than equivalent figures in neighbouring countries.
So why has Laos been so successful at keeping the epidemic at bay?
'Safely cut off'
One factor is the isolation of the country in recent decades.
Laos has not seen the kind of large scale migration which has caused
much social dislocation in other parts of East Asia.
Laos also has virtually no recorded use of intravenous drugs - a key
factor in transmitting HIV elsewhere.
The Lao Government has won much praise for recognising the threat of
HIV-AIDS early on, and for acting swiftly to educate its population.
'Imaginative education'
The Lao authorities, supported by international agencies, have used
imaginative means to get their message to even the remotest villages,
from mobile puppet shows to elephants draped with condom adverts.
During the World Cup in June 2002, condom advertisements were flashed on
the television every few minutes to reach the mobile male population who
are considered at most risk of spreading HIV.
But there is growing concern that, as Laos opens up to the outside
world, its record as one of Asia's Aids success stories could be at risk.
Laos is building roads to connect itself to the rest of the region.
Major all-weather routes are under construction linking Kunming in
southern China to the northern Thai city of Chiang Rai.
Also planned is an East-West economic corridor linking Thailand to
Vietnam via Laos.
'Unwanted imports?'
And soon it will be possible, for the first time, to drive the length of
the country from north to south on a single highway known as Route 13.
It is all part of the Lao Government's efforts to sell itself as
"land-linked" rather than land-locked. The aim is to attract tourism and
investment.
But this is not all the roads could bring in.
"What these roads will carry are drugs, girls and viruses," says David
Feingold, one of the HIV-AIDS co-ordinators for the cultural section of
UNESCO in Bangkok.
He says the expected influx of construction workers from southern China
and Thailand, along with prostitution and intravenous drug use, could
overwhelm a country which is ill-prepared to cope with such dislocation.
"Laos is a country of minorities," he adds. "Many of these minorities
have been relatively isolated for centuries.
"Now you have road building crews coming in, they're without women, and
they are able to entice local women because they have good economic
resources. People are not prepared to deal with the threat that that
poses.
"This is not necessarily an argument to say we should keep people in
some sort of pristine nature reserves. But it is saying that if you
build roads, you have to be careful not only of the environmental
degradation that roads can cause but also the human degradation," he
says.
The international lending agencies who are funding the projects have
agreed to provide HIV-AIDS education to the migrant workers who build
the roads and the truck drivers who will use them.
But many fear their efforts are too little, too late.
"Organisations like the Asian Development Bank, like the World Bank that
finance these large infrastructure projects have social impact
studies,says David Feingold. "But these often get shoved in a drawer and
ignored."
The leading AIDS campaigner in Laos is Dr Chansy Phimphachanh, who heads
the National Council for Control of Aids.
She has done much to ensure that the international aid given to Laos to
combat Aids has been spent wisely, no mean feat in a political culture
where corruption is endemic.
'Increasing awareness'
Dr Chansy's approach is energetic and decidedly low-tech.
She thinks nothing of producing a bunch of bananas to demonstrate to a
group of young Lao men how they should put on a condom.
These days, she's a worried woman.
"We really have to prepare our communities to be HIV resistant," she
says. "We have to prepare them to raise their awareness so they can
protect them from HIV-AIDS."
But she insists that for Laos, remaining isolated is not an option.
"For the development of the country, we mustn't be selfish. For the
wealth of the country, we have to open ourselves up. But at the same, we
don't blame anybody. We have to really teach our people to understand
everything."

An advertisement that depicts a woman carrying a goldfish in a water-filled condom was pulled from television in communist Laos after authorities deemed it too explicit, a US-based voluntary group that sells condoms said Monday. Population Services International produced the humorous ad
to promote its "Number One" brand condom, which it sells at a
subsidized price in Laos, a traditionally conservative Buddhist
society. The ad shows a woman using a water-filled condom to
carry a goldfish after a plastic bag she had been using burst. A
slogan on the screen says, "Number One can save your life."
Sythong Ouansengsy, marketing manager for PSI Laos, said that the
ad had been aired on state television for the past year,
sometimes two or three times a day. But recently the Culture
Ministry told PSI that the ad was too "sensitive because it
showed a condom on TV," said Sythong. The ministry said "boys and
girls watch TV too... during the daytime and it's not good," he
said.
Culture Minister Kheckeo Soisaya said the ad was pulled
because it failed to show how condoms can prevent the spread of
HIV. "They put a goldfish in a condom and give the impression
that condoms protect everything," said Khecko. "They [PSI] should
produce an ad that shows how condoms can prevent AIDS." Khecko
said the Laotian government still supported the work of PSI. PSI
has replaced the ad with a few older spots that only show the
packaging and brand name, Sythong said.
In 1999, it was estimated that less than 0.05 percent of
adults had HIV. The government has said the promotion of condoms
may have helped prevent the spread of the virus in Laos. The
communist regime that has ruled Laos since 1975 keeps a tight
control on media.

Successful promotion of condom use in Laos may have helped
forestall AIDS epidemic hitting some of its neighboring Southeast
Asian countries. A study of sexual behavior in Laos found that,
as in Thailand and Cambodia, many men have multiple sexual
partners. But in Laos the rate of HIV infection is estimated to
be just 5 adults in 10,000 or 0.05 percent. In Myanmar, also
known as Burma, UN statistics say the rate is 1.99 percent, in
Thailand, 2.15 percent and in Cambodia, 4.04 percent, or 80 times
that in Laos.

The survey of several thousand people in five provinces,
conducted last year by the National Committee for the Control of
AIDS under the Ministry of Health, found high levels of reported
condom use in commercial sex transactions. It said that nearly 75
percent of female sex workers reported that they always used
condoms when having sex with clients. Among active, high-risk
groups of clients, two-thirds of police and soldiers and three-
quarters of truck drivers said they always used condoms with paid
partners.

Myanmar, Laos: H.I.V. Spreading02/09/00 -- New York Times

New research from the Johns Hopkins School of Public Health shows
that HIV is spreading in the Asian region known as the Golden
Triangle. According to the report, the virus is moving along
heroin trafficking routes from Myanmar and Laos. Lead researcher
Chris Beyrer said the data show "a clear and urgent need" for
neighboring countries like China, India, and Vietnam, in addition
to Myanmar, to focus more on HIV prevention.

Facing the AIDS Time Bomb31/10/97 -- IPS Wire

Although Laos has so far avoided the high rates of HIV infection affecting nearby populations in Burma, Vietnam, Cambodia, and Thailand, the epidemic remains a serious threat. "As Laos begins to capitalize on its location at the heart of the sub-region, as a transit point or hub for increased trade and
interaction with and between neighbors, the risk and vulnerability to HIV of once isolated communities will also rapidly increase," said United Nations resident coordinator Anne Sutherland at a recent AIDS conference. Increasing urbanization and population mobility, coupled with rising rates of drug use
and a burgeoning prostitution industry, could facilitate a burst in infection rates.

AIDS statistics recently released by the Laotian government paint an
unrealistic picture of the spread of the disease in Laos, a United Nations official said. Laos has announced that 157 cases of HIV were reported in the country between 1989 through 1996. Of these,
33 patients developed AIDS and 23 have died, according to figures released in official media. AIDS in Laos is found mostly in urban areas and transmission is greatest through heterosexual sex.

LAOS SPARK FEARS OF AIDS RISK
Apr 16, 1997

The rising number of Laotians who cross illegally into Thailand to work may be putting Laos at risk of an AIDS epidemic, a researcher has claimed. From each village within 50 kilometres of the border, 30 to 40 young people were crossing the Mekong, said the researcher, who has conducted a survey in southern Laos, the nation's most productive and populous region, on behalf of a development project.

"A number of people work in the sex trade. And they return from time to time. There is a real risk of introducing AIDS to villages which have no means to protect themselves." Condoms were not available in some villages or were too expensive for poor farmers, he said. -- By DONALD MORRIS, SOUTH CHINA MORNING POST